Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies
Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies
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DOI：
10.1186/1471-2296-15-44
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发表时间：
2014-03-07
影响因子：
2.9
通讯作者：
Wearden, Alison
中科院分区：
文献类型：
--
作者：
Bayliss, Kerin;Goodall, Mark;Wearden, Alison
背景资料：慢性疲劳综合征/肌痛性脑脊髓炎（CFS/ME）的NICE指南强调需要在初级保健中进行早期诊断，并根据患者需求进行管理。然而，全科医生可能不愿意作出诊断，并不确定如何管理的人与condition.Methods：发表的定性研究进行了Meta合成，产生一个多角度的描述的障碍CFS/ME的诊断和管理，以及一些卫生专业人员已经能够克服它们的方式。分析提供了二阶的原始调查结果的解释，并开发了三阶结构，以提供建议，为medical course.Results：21定性研究。文献表明，20多年来，卫生专业人员报告了有限的理解CFS/ME. Working的框架内的生物医学模型也导致一些GP怀疑的存在条件。全科医生谁提供的诊断往往有一个更广泛的，多因素的，模型的条件和更积极的态度CFS/ME. These全科医生与患者合作，以达成协议的症状管理，并利用他们的治疗技能，以促进自我care.Conclusions：为了解决障碍CFS/ME的诊断和管理在初级保健，生物医学模型的局限性需要得到承认。建议采取更灵活的生物心理社会方法，医学院培训的目的是使从业人员具备理解、支持和管理患者所需的技能，并提供一个寻求专家意见的途径。
Background: The NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition.Methods: A meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum.Results: Twenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care.Conclusions: In order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input.